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Intravenous atropine treatment in infantile hypertrophic pyloric stenosis
H Kawahara1, K Imura, M Nishikawa
1Division of Paediatric Surgery, Osaka Medical Centre and Research Institute for Maternal and Child Health, Osaka, Japan. kawahara@pedsurg.med.osaka-u.ac.jp
Insights
Intravenous atropine effectively treats infantile hypertrophic pyloric stenosis (IHPS), significantly reducing pyloric muscle thickness and resolving projectile vomiting in most infants. This new regimen offers a promising, non-surgical therapeutic option.
Area of Science:
- Pediatric Gastroenterology
- Neonatal Surgery
Background:
- Infantile hypertrophic pyloric stenosis (IHPS) is a common neonatal surgical condition.
- Pyloric hypertrophy necessitates surgical intervention in many cases.
Purpose of the Study:
- To evaluate the efficacy of a novel intravenous atropine treatment regimen for IHPS.
- To specifically assess the impact of atropine on pyloric hypertrophy regression.
Main Methods:
- Nineteen infants diagnosed with IHPS received intravenous atropine (0.01 mg/kg, 6x/day).
- Successful treatment involved transition to oral atropine (0.02 mg/kg, 6x/day) with gradual dose reduction.
- Diagnosis was confirmed via radiographic and ultrasonographic imaging.
Main Results:
- 89% of infants (17/19) ceased projectile vomiting with atropine therapy (IV median 7 days, oral median 44 days).
- Ultrasonography revealed a significant decrease in pyloric muscle thickness (p < 0.05).
- Infants showed improved thriving status at 6 months (p < 0.01).
Conclusions:
- Intravenous atropine therapy provides satisfactory clinical recovery for IHPS.
- The treatment leads to significant reduction in pyloric muscle thickness, offering a non-surgical approach.
Aims:
To assess the efficacy of a new regimen of intravenous atropine treatment for infantile hypertrophic pyloric stenosis (IHPS) with special reference to regression of pyloric hypertrophy.
Methods:
Atropine was given intravenously at a dose of 0.01 mg/kg six times a day before feeding in 19 patients with IHPS diagnosed from radiographic and ultrasonographic findings. When vomiting ceased and the infants were able to ingest 150 ml/kg/day formula after stepwise increases in feeding volume, they were given 0.02 mg/kg atropine six times a day orally and the dose was decreased stepwise.
Results:
Of the 19 infants, 17 (89%) ceased projectile vomiting after treatment with intravenous (median seven days) and subsequent oral (median 44 days) atropine administration. The remaining two infants required surgery. No significant complications were encountered. Ultrasonography showed a significant (p < 0.05) decrease in pyloric muscle thickness, but no significant shortening of the pyloric canal after completion of the atropine treatment. The patients exhibited failure to thrive at presentation, but were thriving at 6 months of age (p < 0.01).
Conclusions:
This atropine therapy resulted in satisfactory clinical recovery. Pyloric muscle thickness was significantly reduced.